By C. Sophia Carvajal and Aakanksha Deoli
The rapid growth of telemedicine during the COVID-19 pandemic was instrumental in ensuring continued healthcare access through the virtual delivery of healthcare services. Doing so led to a significant increase in healthcare access among the disadvantaged and minority groups in the U.S. The Latinx population in the U.S., one of the fastest growing racial or ethnic minority groups, saw a 295.5 percent increase in telehealth visits since pre-pandemic rates.
Accessing health care is difficult for many people, but especially for communities of color. Latinx people are prone to health disparities, primarily due to low health insurance rates, fear and distrust due to immigration status, language barriers, cultural incompetence, and lack of transportation.
Low rates of health insurance and an inability to pay for healthcare are evident barriers to healthcare access. Many people of color are not eligible for employer-based health insurance and therefore, must buy private insurance or enroll in public insurance, if eligible. According to the United States Census Bureau, 17.7 percent of Latinx people are uninsured, among the highest racial/ethnic subgroups in the country. Consequently, many avoid or delay seeking healthcare, inevitably leading to poor health outcomes.
Fear and distrust pertaining to citizenship status and deportation is yet another barrier to seeking health care. Various studies have suggested that obtaining health services is challenging for individuals lacking legal status. Additionally, evidence indicates that U.S. Immigration and Customs Enforcement’s collaboration with local law enforcement agencies has worsened the fear of utilizing free public health services. Undocumented immigrants are, furthermore, not eligible to receive any financial assistance for health insurance as per the Patient Protection and Affordable Care Act.
When assessing Latinx people’s perceptions of telemedicine, studies show this population can be inclined toward not seeing physicians in person. In a recent study of 32 undocumented Latino immigrants, researchers found that they tended to avoid emergency room visits and replaced non-serious visits with telemedicine during the pandemic.
Language barriers and cultural incompetence are hard to ignore when examining the challenges that people of color face. They significantly impact healthcare access among Latinx communities by influencing patient-provider communication. This cultural divide is often responsible for adverse health outcomes and patient experiences. According to Pew Research Center, 44 percent of Hispanic adults feel that miscommunication due to language and cultural differences is one of the major reasons for poor health outcomes in the Latinx population in the U.S.
Telehealth is a plausible solution to overcome poor communication as it diversifies the options, allowing consumers to choose from a larger group of culturally competent providers. Additionally, using therapeutic tools for transitioning to telemedicine practices called T-HOLA[1] can help physicians engage with Latinx communities through motivational interviewing and increased consideration of cultural values. However, since most telehealth platforms do not offer bilingual or translated services, telehealth’s advantages are often inaccessible to non-English speakers. Such services would advance the accessibility of telehealth services for this population.
Moreover, in the U.S., Latinx populations use technology at similar rates to other groups, with smartphone use at 79 percent compared to White Americans at 82 percent and Black Americans at 80 percent. Their use of day-to-day technology, such as smartphones, for doctors’ visits could be a key element in closing the health disparities gap among Latinx communities.
Lastly, access to transportation also has a considerable influence on healthcare access. Twenty-seven percent of Latinx people in the U.S. rely on public transport, in contrast to 14 percent of their white counterparts. In addition, they typically may not live in close proximity to a healthcare provider. Moreover, in a survey by the U.S. Bureau of Labor Statistics, 50 percent of Latinx people said that their jobs do not offer paid time off. Not to forget, childcare may not be very affordable for many low-income Hispanic households. Evidence suggests that telehealth makes healthcare more convenient and therefore, could increase healthcare access in people facing challenges with paid time off or transportation.
Despite the numerous potential benefits of telehealth, several challenges must be addressed to facilitate the adoption and expand the utilization of telehealth in the Latinx community. The key challenges include lack of privacy at home, restricted access to Wi-Fi or the internet, and inadequate access to an adequate device.
Taken together, although various studies are challenging the success of telemedicine in Latinx communities, there is reasonable evidence showing potential for increased access to care among this population. However, to expand healthcare access with telehealth utilization, robust policy changes are needed to overcome the obstacles that the Latinx population, in particular, faces.
Sophia Carvajal is an undergraduate student at the School of Art & Sciences at Rutgers, The State University of New Jersey.
Aakanksha Deoli, MHA is an Instructor of Teaching and UG Internship Coordinator at Edward J. Bloustein School at Rutgers, The State University of New Jersey.
References:
[1] T-HOLA: “(the word hola means hello in Spanish), an acronym designed to offer practical guidance to providers engaging Latinx patients in telehealth interventions through the application of motivational interviewing skills and consideration of cultural values: (1) orient to Telehealth; (2) engage in Health education; (3) provide Options; (4) utilise active Listening skills; and (5) assess Adherence to cultural values.”